Provider Demographics
NPI:1134299167
Name:FISHER, DEBORAH E (PSY D LP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:FISHER
Suffix:
Gender:F
Credentials:PSY D LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:8170 33RD AVE S - MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-7900
Mailing Address - Fax:651-254-7904
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MC 41104C
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7900
Practice Address - Fax:651-254-7904
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2297103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680001580Medicare ID - Type Unspecified